Citation Nr: 0811530
Decision Date: 04/08/08 Archive Date: 04/23/08
DOCKET NO. 05-36 425 ) DATE
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On appeal from the
Department of Veterans Affairs Regional Office in Muskogee,
Oklahoma
THE ISSUES
1. Whether new and material evidence has been submitted to
reopen a claim of entitlement to service connection for
residuals of tuberculosis.
2. Entitlement to service connection for liver damage and
hepatitis, claimed as due to isoniazid (INH) therapy.
3. Entitlement to service connection for endocrine system
damage and diabetes mellitus, claimed as due to INH therapy.
4. Entitlement to service connection for sleep apnea.
5. Entitlement to service connection for neuropathy of the
right upper extremity.
6. Entitlement to service connection for neuropathy of the
left upper extremity.
7. Entitlement to service connection for neuropathy of the
right lower extremity.
8. Entitlement to service connection for neuropathy of the
left lower extremity.
9. Entitlement to service connection for diabetic
retinopathy blindness.
10. Entitlement to service connection for headaches.
REPRESENTATION
Appellant represented by: Disabled American Veterans
ATTORNEY FOR THE BOARD
K. J. Kunz, Counsel
INTRODUCTION
The veteran served on active duty from March 1966 to March
1971.
This appeal comes before the Board of Veterans' Appeals
(Board) from a June 2004 rating decision by the Muskogee,
Oklahoma Regional Office (RO) of the United States Department
of Veterans Affairs (VA). In that decision, the RO denied
reopening of a previously denied claim for residuals of
tuberculosis. The RO denied service connection for liver
damage with hepatitis, endocrine system damage with diabetes
mellitus, sleep apnea, neuropathy of the right and left upper
and right and left lower extremities, diabetic retinopathy
blindness, and headaches.
The appeal is REMANDED to the RO via the Appeals Management
Center (AMC), in Washington, DC. VA will notify the
appellant if further action is required.
REMAND
The Board will remand the case to obtain additional evidence
relevant to the claims. The veteran was separated from
service in 1971. The claims file contains some records of
medical treatment of the veteran in the 1990s and 2000s. The
evidence in the file does not any treatment of the veteran
directly after service, in the 1970s and 1980s, for
tuberculosis residuals, hepatitis, diabetes mellitus, sleep
apnea, neuropathy of the upper and lower extremities,
diabetic retinopathy blindness, and headaches. The Board
will remand the case for the RO to ask the veteran to
identify the physicians and facilities that have treated him,
and for the RO to obtain treatment records from the sources
the veteran identifies.
The veteran attributes some of his disorders, including
hepatitis and diabetes, to the drug, INH, that was prescribed
to him during service. He attributes other disorders,
including sleep apnea, neuropathy of the upper extremities,
and headaches, to neck injury in a motor vehicle accident
during service. On remand, the veteran should have VA
medical examinations, with review of the claims file, and
opinions regarding the likely etiology of the disorders for
which he is claiming service connection. 38 C.F.R.
§ 3.159(c)(4) (2007).
Accordingly, the case is REMANDED for the following action:
1. Ask the veteran to identify the
sources and dates of treatment he has
received since service for tuberculosis or
tuberculosis residuals, hepatitis,
diabetes mellitus, sleep apnea, neuropathy
of the upper and lower extremities,
diabetic retinopathy blindness, and
headaches. The veteran should provide the
names, and as much address information as
possible, and the approximate years of
treatment, for the physicians, hospitals,
and other practitioners or facilities from
which he received treatment for those
disorders from March 1971 forward. The RO
should obtain records of treatment of the
veteran from the sources that the veteran
identifies.
2. Thereafter, schedule the veteran for a
VA medical examination or examinations to
address the nature and likely etiology of
any current tuberculosis residuals,
hepatitis, diabetes mellitus, sleep apnea,
neuropathy of the upper and lower
extremities, diabetic retinopathy
blindness, and headaches. The examiner
must be provided with the veteran's claims
file for review. If the general medical
examiner recommends specialist
examinations with respect to any of the
claimed disorders, such examinations
should be performed. The examiner or
examiners should explain the reasons for
the opinions expressed. The specific
questions to be addressed are as follows:
A. The veteran had positive tuberculosis
tests during service, and received medical
treatment as a result of those test
results. The medical records, however, do
not make clear to a lay person whether the
veteran had tuberculosis during service.
After examining the veteran and reviewing
the claims file, the examiner should
express opinions as to whether the veteran
had tuberculosis during service, and
whether the veteran has any current
disorder attributable to past
tuberculosis.
B. The veteran asserts that he developed
hepatitis as a result of isoniazid (INH)
therapy during service in the late 1960s
and early 1970s. The examiner should
express an opinion regarding the likely
etiology of any current hepatitis,
including whether it is at least as likely
as not that current hepatitis is causally
related to INH therapy during service or
to other disease, injury, or exposure
during service.
C. The veteran asserts that he developed
diabetes mellitus as a result of INH
therapy during service in the late 1960s
and early 1970s. After examining the
veteran and reviewing the claims file, the
examiner should express an opinion as to
whether it is at least as likely as not
that the veteran's diabetes is causally
related to INH therapy during service or
to other disease, injury, or exposure
during service.
D. The veteran reports that he has
symptoms that are like sleep apnea, except
without respiratory distress. The
examiner should ask the veteran to explain
what symptoms he has. After examining the
veteran and reviewing the claims file, the
examiner should provide a diagnosis as to
whether the veteran has sleep apnea, or
any other disorder manifested by the
reported symptoms. With respect to any
current sleep apnea or other disorder
manifested by the reported symptoms, the
examiner should express an opinion as to
whether it is at least as likely as not
that the disorder is causally related to
service.
E. The veteran reports that he has
neuropathy in both upper and both lower
extremities. He notes that he had neck
symptoms following a motor vehicle
accident during service in 1970. The
examiner should provide a diagnosis as to
whether the veteran has neuropathy in each
of the upper and lower extremities. For
those extremities where neuropathy is
present, the examiner should express an
opinion as to whether it is at least as
likely as not that the neuropathy is
causally related to service, including
neck injury in a motor vehicle accident
during service.
F. The veteran reportedly has diabetic
neuropathy blindness. After examining the
veteran and reviewing the claims file, the
examiner should provide an opinion as to
whether the veteran's blindness resulted
from diabetes mellitus.
G. The veteran reports having frequent or
severe headaches, which he attributes to
neck injury from a motor vehicle accident
during service. After examining the
veteran and reviewing the claims file, the
examiner should provide a diagnosis as to
the type of headache disorder the veteran
has, and an opinion as to whether it is at
least as likely as not that the current
headache disorder is related to service,
including neck injury in a 1970 motor
vehicle accident.
3. After completion of the above, the RO
should review the expanded record and
determine if the veteran's claims can be
granted. If any claim remains denied, the
RO should issue a supplemental statement
of the case and afford the veteran an
opportunity to respond. Thereafter, the
case should be returned to the Board for
appellate review.
The Board intimates no opinion as to the ultimate outcome of
this case. The veteran has the right to submit additional
evidence and argument on the matters that the Board has
remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999).
This claim must be afforded expeditious treatment. The law
requires that all claims that are remanded by the Board of
Veterans' Appeals or by the United States Court of Appeals
for Veterans Claims for additional development or other
appropriate
action must be handled in an expeditious manner. See 38
U.S.C.A. §§ 5109B, 7112 (West Supp. 2007).
_________________________________________________
M. E. LARKIN
Veterans Law Judge, Board of Veterans' Appeals
Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Appeals for Veterans Claims. This remand is in the
nature of a preliminary order and does not constitute a
decision of the Board on the merits of your appeal.
38 C.F.R. § 20.1100(b) (2007).